Unmet HEALTH care needs among elderly in Turkey between 2008-2019 and associated with socio-economic variables

ABSTRACT The aim of the study is to determine the prevalence of unmet health care needs in individuals over the age of 65 between 2008 and 2019 in Turkey, to determine its relationship with socioeconomic factors and evaluate the change over time. In this cross-sectional study, the micro datasets of the Turkish Health Researches conducted by the Turkish Statistical Institute (TUIK) six times were used. The dependent variable of the study is the unmet health care needs. The presence of 3 items was evaluated to determine the need for health care. The presence of at least one of the conditions of chronic diseases, dependence on basic daily living activities and poor health perception determined the need for health care. Unmet healthcare need was accepted as not receiving service from any of the family physicians/practitioners, specialist physicians or home health services units in the last 12 months. The main independent variables are socioeconomic variables. These are income status, education level, employment status, marital status, household type, household size, health insurance and social support. Other variables are demographic variables such as age, gender, and variables related to health status and determination of health. Chi-square test was used in univariate analyzes and Logistic regression analysis was used in multivariate analyzes. Numerical data are presented as mean and standard deviation. Categorical data are presented as numbers and percentages. A total of 55.7% of research group are female and 35.3% are 65-69 years old. Among the research group, 55.7% are female and 35.3% are 65-69 years old. The rate of those with an income below the minimum wage is 56.5%, the rate of working elderly people is 9.7%, and the retirement rate is 34.8%. In total, the rate of health insecurity is 4.2%. The presence of social support is 93.1% in total. The rate of those with at least one chronic disease is 69.0%, the rate of those full dependence on at least one of the ADL (Activity of Daily Living Index) is 8.8%, and the rate of those with poor health perception is 33.2%. The rate of those using any health service in the last 12 months is 88.3%. The prevalence of healthcare need is 75.5% for all components; has increased slightly over the years. When evaluated among those in need, the prevalence of unmet health care needs is in total 7.4% according to all components, 6.7% according to presence of chronic disease, 10.4% according to dependency on the ADL, and 7.4% according to the perception of poor health. As a result of the multivariate analysis in which the effect of socio-economic characteristics on the unmet health care needs was evaluated; after adjusting for all variables, having an income below the minimum wage increases the risk of unmet healthcare needs by 1.45 (95% CI: 1.01-2.09) times. Working the elderly increases the risk of unmet healthcare needs by 1.37 (95% CI: 1.01-1.85) times. Lack of health insurance increases the risk of unmet healthcare needs by 2.70 (95% CI: 2.07-3.51) times. The elderly living alone with their spouse increases 1.71 (95% CI: 1.02-2.84) times. According to this study, it has been determined that the most important issues related to the unmet health care needs and accordingly the elderly health are the income level, social security (retirement right), health insurance, and cohabitation. A retirement period where there is social security and the income level is not below the minimum wage will reduce the health risks that may emerge due to inability to receive service or inadequate and inappropriate service by reducing unmet needs. Lack of health insurance is the most important risk factor in every age group, the effect of which never changes. It should be ensured that all elderly people are covered by health insurance. KEYWORDS: Elderly, healthcare need, unmet need, Turkey